Ch 3 Toxicity - Questions From Book

A client with recurrent urinary tract infections was prescribed sulfamethoxazole-trimethoprim and experienced an allergic reaction. The client states, "I don't understand. I had a two-day course of the same drug last year with no problems." What is the nurse's best response?

"Allergic reactions happen after your body has been sensitized to a drug in the past."

Drugs can affect the special senses, including the eyes and ears. Alterations in seeing and hearing can pose safety problems for clients. What are examples of sensory effects of drugs?

- A 4-year-old admitted after taking too many aspirin - A 45-year-old taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis

A patient is taking a drug that is known to be toxic to the liver. The patient is being discharged to home. What teaching points related to liver toxicity and the drug should the nurse teach the patient to report to the physician?

- Fever; changes in the color of urine - Changes in the color of stool; malaise - Yellowing of the skin or the whites of the eyes

A client is prescribed a combination of medications to treat the disease process. The client is exhibiting signs of toxicity related to the new drug regimen. A possible cause of the change in the absorption of the medications may be enzyme inhibition. What is true of enzyme inhibition? (Select all that apply.)

- It may occur with concurrent administration of two or more drugs that compete for the same metabolizing enzymes. - It may necessitate the administration of smaller doses of the medication. e. It occurs within seconds or minutes of starting an inhibiting agent.

Many drugs can affect the functioning of the nerves in the periphery and central nervous system. Which are examples of potential neurologic effects of drugs? Select all that apply.

- a postoperative client with extrapyramidal symptoms, hyperthermia, and autonomic disturbances - a client taking an antipsychotic who exhibits akinesia, muscular tremors, drooling, changes in gait, jitters (akathisia), or spasms (dyskinesia) - a postoperative client who had atropine and exhibits dry mouth, altered taste perception, dysphagia, heartburn, constipation, and bloating

Which medication classifications cause blood dyscrasias? (2)

- antibiotics - antineoplastics

The nurse provides health education for a diverse group of clients. For which client should the nurse emphasize the risk of teratogenic drug effects?

20-year-old female client who has been diagnosed with a chlamydial infection

The nurse is caring for a client receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which will alert the nurse that the client may be experiencing nephrotoxicity?

A decrease in urine output

The nurse should have basic knowledge of drug classifications in order to administer medications safely to clients. What drug information is instrumental in determining nursing actions following drug administration?

Adverse effects

client is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the client develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is:

Allergic reaction

Upon assessment after giving oral penicillin, the nurse notes that a client has dilated pupils, increased blood pressure, and increased heart rate. The nurse would document these findings as which type of drug allergic reaction?

Anaphylatic Reaction

What is an example of a secondary action?

Antihistamines causes drowsiness

When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide.

Based on the nurse's understanding, this drug is used to treat: hyperglycemia

Patients receiving antineoplastic drugs that disrupt cell function often have adverse effects involving cells that turn over rapidly in the body. These cells include

Bone marrow cells

Decreased urinary output, elevated bun, increased serum creatinine, altered acid-base balance, and electrolyte imbalances

Can occur with nephrotoxicity

A client is receiving a drug to lower blood glucose level. What would lead the nurse to suspect that the client's blood glucose level was too low?

Cold clammy skin

Topical corticosteroids may be used to treat

Dermatological reactions such as a rash

A client who is being treated for cancer developed a serum sickness reaction. The care team has been notified, and the client is being stabilized. What is the nurse's priority action?

Discontinue the drug immediately as ordered.

What would the nurse include in the teaching plan for a client who is to receive a drug that is associated with anticholinergic effects?

Drink plenty of fluids to prevent dehydration

A client is suspected of having a liver injury as a result of drug therapy. What laboratory finding would best support this diagnosis?

Elevated aspartate aminotransferase (AST) level

Pregnant women should be advised of the potential risk to the fetus any time they take a drug during pregnancy. What fetal problems can be related to drug exposure in utero?

Fetal death Nervous system disruption Skeletal and limb abnormalities Cardiac defects Low-set ears Deafness

A client develops stomatitis from drug therapy. Which measure would be mostappropriate for the nurse to suggest?

Frequent rinsing with cool liquids

A client is diagnosed with hypercholesterolemia and is prescribed a STATIN. As part of client education, the nurse should teach the client to avoid eating:

Grapefruit

Urinary retention in a client with an enlarged prostate taking an anticholinergic agent is an example of

Hypersensitivity

A patient taking glyburide (an antidiabetic drug) has his morning dose and then does not have a chance to eat for several hours. An adverse effect that might be expected from this would be

Hypoglycemia

has begun lithium therapy. What is the primary rationale for the nurse's instructions regarding the need for regular monitoring of the client's serum drug levels?

It is necessary to ensure that the client's drug levels are therapeutic but not toxic.

Glipizide (Glucotrol) is an antidiabetic agent with the desired action of lowering the blood glucose level.

Lowering the blood glucose level

A client in the ambulatory care clinic is experiencing shortness of breath and facial and throat edema while receiving a pegloticase infusion. What is the nurse's best action?

Notify emergency personnel

A client with a longstanding diagnosis of schizophrenia has taken antipsychotic drugs for several decades. For what adverse effect should the nurse assess

Parkisonian symptoms

The nurse is assessing a client whose debilitating headache did not respond to the recommended dose of an OTC analgesic. In response, the client took another dose 30 minutes later and then a double dose one hour after that. The nurse's assessment should focus on the possibility of:

Poisoning

A client began a new medication four days ago and presents with a temperature of 38.2° C (100.8 °F), dependent edema, and swollen cervical lymph nodes. The nurse has informed the client's provider, who has discontinued the medication. What subsequent intervention should the nurse prioritize?

Provide supportive care to manage fever and inflammation.

A client is experiencing a reaction to the penicillin injection that the nurse administered approximately ½ hour ago. The nurse is concerned that it might be an anaphylactic reaction. What signs and symptoms would validate her suspicion

Rapid heart rate Diaphoresis Rash Client report of a panicky feeling

histamine, which is responsible for many symptoms of allergy

Redness, swelling, itching, rash, and hives

A patient with a severe infection is given gentamicin, the only antibiotic shown to be effective in culture and sensitivity tests. A few hours after the drug is started intravenously the patient becomes very restless and develops edema. Blood tests reveal abnormal electrolytes and elevated blood urea nitrogen. This reaction was most likely caused by

Renal toxicity associated with gentamicin

A client with a history of schizophrenia has developed severe drug-induced parkinsonism from treatment with antipsychotic medications. What nursing diagnosis should the nurse identify

Risk for aspiration related to impaired swallowing

A client, prescribed a drug that has an exceptionally narrow margin of safety, should be educated about the need for what intervention?

Serum drug level monitoring

Which skin condition would be most likely to cause increased systemic absorption of a topical medication?

Severe sunburn

An elderly client has been taking a new medication for 2 months. During a follow-up visit, the client's son tells the nurse that he feels his mother's memory is getting worse. What concerns should the nurse have at this time?

This may be coincidental, and the memory loss may be attributed to changes with aging

Systemic absorption from the skin is minimal but may be increased when the

When the skin is inflamed or damaged

Dizziness is the result of low blood pressure, which is what kind of action?

Which is a primary action

Grapefruit contains a substance that strongly inhibits the metabolism of drugs normally metabolized by the cytochrome P450 CYP3A4 enzyme. This effect greatly increases the blood levels of some drugs (e.g., the widely used "statin" group of cholesterol-lowering drugs), and the effect lasts for several days. Clients who take medications metabolized by the CYP3A4 enzyme should be advised

against eating grapefruit or drinking grapefruit juice

An example of a drug allergy is

breathing difficulty after an injection of penicillin

The nurse is assessing a number of clients on the acute medicine unit. What client is most likely experiencing an adverse effect from the primary action of the medication?

client taking antihypertensives who reports dizziness upon standing

A client is four months' pregnant. She works in the chemical unit of a research department and is responsible for handling various chemicals. Her gynecologist advised her not to expose herself to chemical or industrial vapors and specific drugs. These restrictions are advised because exposure to industrial vapors could:

damage the immature nervous system of the fetus.

In older adults (65 years and older), physiologic changes may alter all pharmacokinetic processes. Changes in the gastrointestinal tract include

decreased gastric acidity, decreased blood flow, and decreased motility.

What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body?

decreased glomerular filtration rate

Many drugs that reach the developing fetus or embryo can cause death or congenital defects. What are examples of congenital defects? (3)

heart defects skeletal and limb abnormalities central nervous system alteration P40

Renal injury

is reflected by elevated blood urea nitrogen and creatinine concentration

Nausea, sexual dysfunction and GI bleeding are what kind type of action?

secondary actions of the medications in question

A woman has had repeated bouts of bronchitis throughout the fall and has been taking antibiotics. She calls the clinic with complaints of vaginal pain and itching. When she is seen, it is discovered that she has developed a yeast infection. You understand that

she has developed a superinfection, because the antibiotics kill bacteria that normally provide protection.

Knowing that a patient is taking a loop diuretic and is at risk for developing hypokalemia the nurse would assess the patient for

weak pulse, low blood pressure, and muscle cramping.

Liver injury

would be reflected by elevated liver enzymes such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT).